Provider Demographics
NPI:1982715686
Name:LPEC MEDICAL EYE CARE PLLC
Entity Type:Organization
Organization Name:LPEC MEDICAL EYE CARE PLLC
Other - Org Name:LAKE PLAINS EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-798-2020
Mailing Address - Street 1:500 ERIE ST SOUTH
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-1010
Mailing Address - Country:US
Mailing Address - Phone:585-798-2020
Mailing Address - Fax:585-798-3365
Practice Address - Street 1:500 ERIE ST S
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-1010
Practice Address - Country:US
Practice Address - Phone:585-798-2020
Practice Address - Fax:585-798-3365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
NY120403332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP017812763OtherBLUE CHOICE ROCHESTER
NY02873274Medicaid
NYP017812763OtherBLUE CHOICE ROCHESTER
NYBA0983Medicare PIN